A joint dislocation occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma to the joint from a direct impact or an indirect impact from a fall. As a paramedic, our main goal is to achieve adequate analgesia and ensure reasonable distal perfusion en route to hospital. If inadequate distal perfusion is possible, the patient should be urgently transported to hospital due to the risk of ischemia to the limb.
Unless specifically trained to do so, paramedics should not routinely attempt to relocate a dislocated joint. Any joint that has been dislocated has the ability to damage surrounding ligaments, tendons, muscles, and nerves. Even in hospital, most patients who have had a dislocation will have an X-ray taken before Medical Staff attempt to reduce the dislocation.
So, what are the priorities as a paramedic treating a joint dislocation?
1. Reassure the patient – they’re limb appears to be in an awkward position, this is going to be frightening.
2. Adequate analgesia – this may mean lots and lots of morphine. Generally, these people are young, fit and healthy (and playing sports) so they can handle a lot of morphine.
3. Check distal perfusion. This means checking the colour, warmth, movement and sensation distally, as well as checking for the presense of a distal pulse.
4. Splint if this can relieve some of the pressure. Generally, a person with a shoulder dislocation will have their arm in the best position for themselves and there is no benefit in trying to adjust the arm so that it looks nice in a sling. Talk to the patient and see if what you’re doing is going to help.
5. Perform a thorough head to toes assessment. If they have had enough trauma to dislocate a joint they are likely to be injured somewhere else.
6. Take them to hospital.